Shiloh Green Manor II

Type of visit: Required - 1 Year

At approximately 11:45 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Licensee/Back Up Administrator Manuel Ortega arrived at 11:50 AM. Shiloh Green Manor II is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents, one (1) of which may be bedridden. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were five (5) residents in care and two (2) staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 12:05 PM, LPA toured the facility with Licensee Ortega. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged on 12/17/2025. The Sonoma County Fire District conducted a Fire & Life Safety inspection on 10/10/2025 and found no violations. The facility was sufficiently lighted. LPA inspected five (5) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 6/2/2026. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were observed to be operational. Continued on 809-C.. ...Continued from 809 At approximately 12:50 PM, LPA reviewed five (5) resident files. Five (5) of five (5) resident files were observed to be well organized and thorough with all required documentation. LPA reviewed four (4) staff files. Four (4) of four (4) staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA audited Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Ligaya Ortega’s Administrator Certification 7004360740 is current with an expiration date of 4/7/2028. Manuel Ortega's Administrator Certification 7000579740 is current with an expiration date of 6/9/2027. LPA requested the following documents be submitted to Community Care Licensing by 6/26/2026. LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Updated Liability Insurance Policy Updated Lease The facility is in compliance. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Licensee Ortega. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 16, 2026

Type of visit: Required - 1 Year

At approximately 8:30 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Care Giver (CG) Aissa Menguilla. Administrator Ligaya Ortega arrived at 8:50 AM. Shiloh Green Manor II is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents, one (1) of which may be bedridden. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were six (6) residents in care and three (3) staff members on-site. At approximately 8:50 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 8:55 AM, LPA toured the facility with Licensee Manuel Ortega. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged on 12/18/2024. The facility was sufficiently lighted. LPA inspected four (4) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 6/10/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 9:35 AM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed to be well organized and thorough with all required documentation. LPA reviewed four (4) staff files. All staff files were observed to be well organized with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Ligaya Ortega’s Administrator Certification 7004360740 is current with an expiration date of 4/7/2026. LPA requested the following documents be submitted to Community Care Licensing by 8/9/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Updated Liability Insurance Policy Updated Lease The facility is in compliance. No deficiencies cited during today's visit. Exit interview conducted. Copy of report and discussed and provided to Administrator Ortega. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 9, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Licensees Joy and John Ortega. There are currently six (6) residents in care. There was a caregiver working with the Administrators during the inspection. Facility has a required infection control plan. Facility has a required emergency disaster plan. Facility has an approved dementia plan. The facility has a hospice waiver for four (4) residents. Facility has a fire clearance approved for six (6) non-ambulatory, of which one(1) may be bedridden. LPA reviewed six (6) resident files. Medication records and storage of medications were checked. All medications were locked and inaccessible to residents in care. LPA reviewed three (3) staff files. All staff have required criminal record clearance. Staff have required training. Staff have first aid certification and cpr as required. Facility had an emergency fire drill/evacuation drill on 7/5/24, record review. LPA toured the facility with the Administrators. Hot water was checked at 118.2 degrees Fahrenheit. All exits were free and clear of obstruction. All exit doors had auditory alarms. Fire extinguishers, two (2), were showing fully charged, were inspected and tagged. Food supply was sufficient. All cleaners/disinfectants were locked and inaccessible to residents in care. Facility was clean and orderly. Facility had a sufficient supply of personal protective equipment (PPE), paper products, hygiene products, linens, and furnishings for resident use. LPA is requesting the following documents be updated and submitted by 8/23/24: LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required- if no changes submit last page with date/signature of review) Infection Control Plan (ensure to review and update as needed/required- if no changes submit last page with date/signature of review) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster No deficiencies cited today.the state’s words, verbatim · CDSS document, Jul 23, 2024